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DE QUERVAIN’S TENOSYNOVITIS (STENOSING TENOSYNOVITIS)


What is De Quervain's tenosynovitis?

This disabling tendinopathy is a degenerative (myxoid) condition affecting two tendons (abductor pollicuslongus and flexor pollicusbrevis) on the thumb side of the forearm. It is seen predominantly in females with a bimodal distribution, affecting females during childbearing age as well as pre-menopausal women.

The condition is poorly understood. The tunnel (first dorsal extensor compartment) wall gets thickened, and the space for the two tendons to move through gets smaller. This friction causes synovitis (inflammation of the tendon sheath) and thickening of the tendon, aggravating it further.

What are the symptoms of De Quervain's tenosynovitis?

Signs and symptoms of De Quervain's tenosynovitis include pain over a very specific place on the radial (thumb) side of the wrist and when doing certain movements like wringing out a cloth or picking a child up under their arms, aggravates the pain. Other symptoms include swelling near the base of your thumb, a squeaking sound when the tendons move within swollen sheaths and sticking or stop-and-go sensation in your thumb when you are moving it.

How is De Quervain's tenosynovitis treated?

Dr van der Spuy may recommend that you avoid aggravating motions, splinting (poor response generally) and steroid injections. Steroid injections tend to work well in about 80% of people. These injections, especially multiple ones, have the potential side effects of decolouration and fat atrophy of the skin at the injection site. The hand specialist may recommend surgical treatment if conservative treatment fails, and based on releasing the sheath of the first dorsal compartment and freeing the tendon from degenerative tissue.

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Rehabilitation post De Quervain’s release

The hand surgeon will immobilise your wrist using a cast for 10-14 days to allow the wound and soft tissues to heal. Immediately post hand surgery it is important to keep the hand elevated, the cast dry and to gently exercise the thumb to keep the tendons gliding through the recently released tunnel.

The hand and wrist doctor will then remove the cast, then check the wound and a light dressing reapplied. A wrist and thumb splint is fabricated to wear for the following two weeks. This splint must be removed five times a day for thumb and wrist exercises, but provides support and pain relief when using the hand. Therapy will include swelling and scar management, wrist and thumb range of movement and strengthening.

The thumb and wrist will likely still be recovering at six weeks post-surgery but should be well healed after three months.


icon-5

DE QUERVAIN’S TENOSYNOVITIS (STENOSING TENOSYNOVITIS)


What is De Quervain's tenosynovitis?

This disabling tendinopathy is a degenerative (myxoid) condition affecting two tendons (abductor pollicuslongus and flexor pollicusbrevis) on the thumb side of the forearm. It is seen predominantly in females with a bimodal distribution, affecting females during childbearing age as well as pre-menopausal women.

The condition is poorly understood. The tunnel (first dorsal extensor compartment) wall gets thickened, and the space for the two tendons to move through gets smaller. This friction causes synovitis (inflammation of the tendon sheath) and thickening of the tendon, aggravating it further.

What are the symptoms of De Quervain's tenosynovitis?

Signs and symptoms of De Quervain's tenosynovitis include pain over a very specific place on the radial (thumb) side of the wrist and when doing certain movements like wringing out a cloth or picking a child up under their arms, aggravates the pain. Other symptoms include swelling near the base of your thumb, a squeaking sound when the tendons move within swollen sheaths and sticking or stop-and-go sensation in your thumb when you are moving it.

How is De Quervain's tenosynovitis treated?

Dr van der Spuy may recommend that you avoid aggravating motions, splinting (poor response generally) and steroid injections. Steroid injections tend to work well in about 80% of people. These injections, especially multiple ones, have the potential side effects of decolouration and fat atrophy of the skin at the injection site. The hand specialist may recommend surgical treatment if conservative treatment fails, and based on releasing the sheath of the first dorsal compartment and freeing the tendon from degenerative tissue.

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Rehabilitation post De Quervain’s release

The hand surgeon will immobilise your wrist using a cast for 10-14 days to allow the wound and soft tissues to heal. Immediately post hand surgery it is important to keep the hand elevated, the cast dry and to gently exercise the thumb to keep the tendons gliding through the recently released tunnel.

The hand and wrist doctor will then remove the cast, then check the wound and a light dressing reapplied. A wrist and thumb splint is fabricated to wear for the following two weeks. This splint must be removed five times a day for thumb and wrist exercises, but provides support and pain relief when using the hand. Therapy will include swelling and scar management, wrist and thumb range of movement and strengthening.

The thumb and wrist will likely still be recovering at six weeks post-surgery but should be well healed after three months.


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